Limits...
Socioeconomic disparity in survival after breast cancer in ireland: observational study.

Walsh PM, Byrne J, Kelly M, McDevitt J, Comber H - PLoS ONE (2014)

Bottom Line: Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression.Survival disparity did not diminish over time, compared with the period 1994-1998.Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.

View Article: PubMed Central - PubMed

Affiliation: National Cancer Registry, Cork, Ireland.

ABSTRACT
We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999-2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21-1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97-1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994-1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.

Show MeSH

Related in: MedlinePlus

Hazard ratios for breast cancer mortality by deprivation stratum, Ireland, 1999–2008: by (a) age of diagnosis and (age-adjusted) by (b) region of residence, (c) Charlson Index of comorbidity, (d) TNM 5th-edition stage, (e) method of presentation, and (f) surgical and hormonal treatment.Trends by deprivation were less heterogeneous for other subgroups.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4221110&req=5

pone-0111729-g006: Hazard ratios for breast cancer mortality by deprivation stratum, Ireland, 1999–2008: by (a) age of diagnosis and (age-adjusted) by (b) region of residence, (c) Charlson Index of comorbidity, (d) TNM 5th-edition stage, (e) method of presentation, and (f) surgical and hormonal treatment.Trends by deprivation were less heterogeneous for other subgroups.

Mentions: To explore our findings further, we also examined possible changes over time in the deprivation-related trend (Figure 5), and variation of the deprivation-related trend across different patient subgroups (Figure 6).


Socioeconomic disparity in survival after breast cancer in ireland: observational study.

Walsh PM, Byrne J, Kelly M, McDevitt J, Comber H - PLoS ONE (2014)

Hazard ratios for breast cancer mortality by deprivation stratum, Ireland, 1999–2008: by (a) age of diagnosis and (age-adjusted) by (b) region of residence, (c) Charlson Index of comorbidity, (d) TNM 5th-edition stage, (e) method of presentation, and (f) surgical and hormonal treatment.Trends by deprivation were less heterogeneous for other subgroups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221110&req=5

pone-0111729-g006: Hazard ratios for breast cancer mortality by deprivation stratum, Ireland, 1999–2008: by (a) age of diagnosis and (age-adjusted) by (b) region of residence, (c) Charlson Index of comorbidity, (d) TNM 5th-edition stage, (e) method of presentation, and (f) surgical and hormonal treatment.Trends by deprivation were less heterogeneous for other subgroups.
Mentions: To explore our findings further, we also examined possible changes over time in the deprivation-related trend (Figure 5), and variation of the deprivation-related trend across different patient subgroups (Figure 6).

Bottom Line: Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression.Survival disparity did not diminish over time, compared with the period 1994-1998.Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.

View Article: PubMed Central - PubMed

Affiliation: National Cancer Registry, Cork, Ireland.

ABSTRACT
We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999-2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21-1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97-1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994-1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.

Show MeSH
Related in: MedlinePlus